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Hyperbilirubinemia as a new diagnostic marker of acute appendicitis

Introduction: Appendicectomy is the most frequently performed urgent abdominal operation, often the first major procedure performed by a surgeon in training. Recently, elevation in serum bilirubin was reported in acute appendicitis, but the importance of the elevated total bilirubin has not been stressed. This study aims to evaluate the sensitivity, specificity, positive and negative predictive value of serum bilirubin as a diagnostic marker of acute appendicitis and its complications. Material and Methods: This prospective study was performed on 100 consecutive patients who were operated on for treatment of acute appendicitis. Clinical diagnosis of acute appendicitis was based on symptoms of abdominal pain, migration of pain, nausea, vomiting, anorexia, fever and signs of peritoneal inflammation like right iliac fossa tenderness, rebound tenderness and guarding. Apart from the routine investigation all the 100 cases were subjected specifically to the following four investigations i.e. Total WBC count, Differential Leukocyte count, CRP and Serum Bilirubin, to evaluate their role in accurately diagnosing a case of acute appendicitis. Results: Of total 100 patient operated for acute appendicitis or its complications, histopathology shows signs of inflammation in only 80. So out of 80 cases of acute appendicitis, 57 (71.25%) had elevated Serum Bilirubin. In those cases 19 (23.75%) had appendicitis associated with complications and 38 (47.5%) had appendicitis without any complications. In the rest 23 (28.75%) patients Serum Bilirubin were normal. Conclusion: The sensitivity, Specificity, predictive value of positive test and predictive value of negative test of Serum Bilirubin in my study is 71.25%, 80%, 93% and 41% respectively.. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia higher than the normal range should be identified as having a higher probability of Acute appendicitis associated with complications suggesting, serum bilirubin levels have a predictive potential for the diagnosis of Acute appendicitis associated with complications.